– At a minimum, three pro-life Democrats from predominantly Catholic districts. They were leaning toward a no vote because the Senate bill is less restrictive on abortion funding than the House bill, but will finally sign on because their districts went Republican in 1994 after Bill Clinton lost health care and they don’t want to repeat history.

– Three or more from strong union districts. They don’t like the Senate’s excise tax on costly plans but will ultimately vote yes because they’re willing to gamble that the Senate will cut the tax when it votes on a reconciliation bill.

– No less than three remaining fence sitters. They’ll vote yes because Nancy Pelosi either threatens to remove their subcommittee chairmanships and eliminate campaign funding from the Democratic Congressional Campaign Committee if they don’t, or promises to give them subcommittee chairs and abundant D.C.C.C. funding if they do.

That gives the president at least 215 votes. Where can he look for another vote if needed? From one or more members who finally conclude that the Senate bill, while unpopular in their district, is nonetheless in the nation’s best interest –- and who have decided there’s really no point to being in politics unless they’re willing to stand for something monumental that they believe is right.

Not all of their concerns need to be satisfied. Just enough to get the 216 votes needed to pass the legislation.
The public should expect to see the leadership and the White House make whatever deals are needed to get simple majorities to pass the legislation in the House and the reconciliation bill in the Senate.

After initially distancing itself from the “Louisiana Purchase and the Cornhusker Deal,” the new position of the White House is that special deals are okay as long as they aren’t “state-specific.” The bar doesn’t get much lower than that.

A majority of American voters are already against the health bills being proposed by the Democrats. What is likely to unfold over the next few weeks — especially if the House uses the “deem and pass” strategy they are now considering in order to avoid literally having to support the Senate bill — will only worsen their already jaundiced view of the Congress and sharpen the bitter partisan divide.

I have to assume the Democratic leadership as well as those members of Congress who are running are prepared for those frustrations to be expressed in November.

If the health care reform legislation does indeed pass, the more relevant question may become whether what passes will ever get implemented. Most of the insurance reforms that begin early will only drive up health care costs. More ominous, the financing strategies begin almost immediately while the major coverage expansions don’t begin until 2013.

The last time that was tried was the Medicare catastrophic-coverage bill which ended up being repealed before the benefits even began. Whatever happens in the next few weeks, it will be no more than health care reform, version 1.0.

But what is true for the party as a whole is not necessarily true for each of its members, and there lies the uncertainty. If congressional Democrats were as disciplined as Republicans, we would be deprived of all suspense about the legislative outcome.

Nonetheless, the underlying pressures favor passage of the bill. Though they might like to see it pass without their votes, most of the House Democrats whose votes are in play have an interest in seeing the legislation enacted. Coming from relatively conservative districts, they are the ones most likely to get wiped out if inaction on health care brings on a Republican tide.

Moreover, the legislation gives the hold-outs grounds to justify a positive vote. The fiscally conservative Blue Dogs can point to the projected reduction in the deficit. Those opposed to abortion can point to the provisions in the Senate bill that impose greater restrictions on insurance coverage of abortions than current law provides.

Those who expect the legislation to fail have history on their side. This time, however, I expect a different result. But if it passes, will it actually be carried out in 2014 as planned? That’s another matter entirely.

The votes Speaker Pelosi must get would mainly come from moderates and conservative members elected in highly competitive districts. Their constituents are trending solidly toward opposition to the bill, primarily for cost reasons.

The Congressional Budget Office estimates the new spending and subsidies to expand insurance coverage would add about $200 billion to the federal budget by 2019. Moreover, that new spending would increase at a rate of about 8 percent annually every year thereafter.

Despite assertions to the contrary, the measures designed to offset the additional spending and slow the pace of rising costs are not nearly as robust and certain to occur.

Two key offsets — the so-called “Cadillac tax” and the permanent cut in inflation payment rate increases for hospitals and other facilities — generate large savings on paper in the second decade of implementation. But the savings will only occur if a future president and a future Congress are more willing than those in office today to put the squeeze on millions of middle-class families with relatively expensive health insurance and to force large numbers of facilities to leave the Medicare program because of low reimbursement rates.

The public is not naïve. They know government entitlement programs have a strong tendency to grow rapidly once put in place. What they see coming down the pike is another under-financed program, at a time when the federal government is already running up the nation’s debt at an unprecedented pace because previous commitments are now unaffordable.

Their concern is well placed, and should be enough to force Congress to come back later with a plan that is less risky for the country’s economic future.

Second, Democratic lawmakers, who ran in 2008 promising to control costs and expand coverage, have already staked so much on health care reform. They spent virtually all of 2009 developing legislation, and they have already voted once on comprehensive reform.

They know that voters will blame them if they fail to act now. The public has concerns about how the legislative process has played out, and questions about the bill’s provisions. But these concerns and questions pale in comparison to their disdain for lawmakers who fail to follow through on a year’s worth of work or vote no after they vote yes.

But most importantly, the public expects Congress to govern and make decisions. In this case, governing means stepping forward to carry out the changes we need in our health care system, which this legislation will make possible.

Opponents of the legislation — insurance companies chief among them — are spending tens of millions of dollars a week to scare Americans. Their arguments are perhaps the best case for reform. Without action, Americans will remain at the mercy of insurance companies when they seek to obtain or switch coverage, costs will continue to rise unabated, and the reach of insurance will continue to decline. Moreover, the political fallout for Democrats — and the blow to Americans’ confidence in government — will be grave.

Saying no to the current legislation is saying no to health security for a long time to come. America’s leaders need to say yes.